Veteran’s Preference: See pamphlet “Veteran’s Preference in Maine State Service” or go to
www.maine.gov/bhr/state_jobs/veteran.htm for more information. Provide DD214 and disability forms if applicable.
c Not Claimed
c 5 Points (Requires DD214)
c 10 Points (Requires DD214 and VA Statement of Disability)
Only U.S. citizens or aliens who have a legal right to work and remain permanently in the U.S. are eligible for employment. Can you, after employment, submit verification of your legal right to work in the United States?
c Yes c No
Are you at least 18 years of age? c Yes c No
Are you a present or former Maine State employee? c Yes c No
Are you willing to work: c Saturdays c Sundays c Holidays
Do you have a current Maine driver’s license? c Yes c No
If yes, what type? c Class A c Class B c Class C
Are you willing to travel on the job? c Yes c No
If yes, are you willing to use your own vehicle? c Yes c No
Are you willing to work overtime? c Yes c No What shifts are you willing to work? c 1st c 2nd c 3rd
ADMINISTRATIVE SKILLS (subject to formal testing and work sampling) WORDS PER MINUTE
Typewriter:
Keyboarding:
FOREIGN LANGUAGE SKILLS
Language __________________________
Speak c
Read c
Write c
Language __________________________
Speak c
Read c
Write c
Geographic Preference
Candidates are asked to specify the geographic areas of the State in which they will accept employment by completing the form below. You may select or change the conditions of your referral by checking the appropriate boxes. Mark the area(s) and condition(s) of employment suitable to you. If you do not select any areas, the bureau will automatically refer your name for all counties and employment types.
F = Full Time P = Part Time T = Temporary S=Seasonal
Important instructions for Completing Employment History
This portion must be accurate and complete. APPLICATIONS LACKING SUFFICIENT INFORMATION WILL BE REJECTED. List your entire work history including part-time, temporary and volunteer jobs. List jobs in reverse order, starting with your present or last job. List each promotion as a separate job. To evaluate your qualifications we must have accurate and complete information on previous job tasks and levels of responsibility. Part or all of your examination score may be based on your work history. Be thorough and specific in the detailing of duties. SPECIAL NOTE: If additional space is needed, attach separate sheets.
Employer #1
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Reason for Leaving:
Employer #2
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Employer #3
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Employer #4
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Employer #5
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Employer #6
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Employer #7
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Employer #8
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Employer #9
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
Employer #10
From (mm/yy): To (mm/yy):
______________________ - ______________________
Complete Address and phone number:
Last Weekly Pay $
Your Title:
Hours/Week:
Number & Titles of Employees You Supervised:
Supervisor’s Name & Title:
Duties:
The State of Maine conducts background checks. Have you ever been convicted of any violation of law by any court of law? Include any guilty pleas entered, military courts martial, traffic violation convictions for Operating Under the Influence (OUI), or traffic violations that resulted in your license being suspended. Do not include any conviction(s) occurring before your 18th birthday or traffic violations not listed above.
Please print your answer (either “Yes” or “No”) in the space provided: __________
If yes, please list: Offense(s) Date of Conviction(s)
___________________________________________________ __________________
___________________________________________________ __________________
___________________________________________________ __________________
___________________________________________________ __________________
Not all conviction(s) will automatically disqualify you from employment but will be considered in relation to specific job requirements. Omission or misrepresentation of this information will result in employment ineligibility.
